Subarachnoid haemorrhage due to intracranial vertebral artery dissection presenting with atypical cauda equina syndrome features: case report

Abstract

Background: Failing to recognise the signs and symptoms of subarachnoid haemorrhage (SAH) causes diagnostic delay and may result in poorer outcomes. We report a rare case of SAH secondary to a vertebral artery dissection (VAD) that initially presented with cauda equina-like features, followed by symptoms more typical of SAH. Case presentation: A 55-year-old man developed severe lower back pain after sudden movement. Over the next 5 days he developed paraesthesiaes in the feet, progressing to the torso gradually, and reported constipation and reduced sensation when passing urine. On day six he developed left facial palsy, and later gradual-onset headache and intermittent confusion. Magnetic resonance imaging of the brain showed diffuse subarachnoid FLAIR hyperintensity, concerning for blood, including a focus of cortical/subcortical high signal in the left superior parietal lobule, which was confirmed by computed tomography. Digital subtraction angiography demonstrated a left VAD with a fusiform aneurysm. Conclusion: We present a very rare case of intracranial VAD with SAH initially presenting with spinal symptoms. The majority of subsequent clinical features were consistent with a parietal focus of cortical subarachnoid blood, as observed on neuroimaging.

Subarachnoid hemorrhage due to intradural cerebral aneurysm and simultaneous spinal subdural hematoma: illustrative case

“…8,[12][13][14] In the case of supratentorial aneurysms, the theory proposed by Yamaguchi et al 13 consists of an infratentorial projection of the hemorrhage, with dissection of the subdural space under the tentorium and migration due to gravity to the spinal canal. The SAHs caused by dissecting lesions of the vertebral arteries [14][15][16] could promote direct invasion of the hemorrhage to the dura mater located in the craniocervical transition.…”

Flow Diversion for Reconstruction of Intradural Vertebral Artery Dissecting Aneurysms Causing Subarachnoid Hemorrhage—A Retrospective Study From Four Neurovascular Centers

“…Intracranial dissections of the vertebral artery (VA) represent rare but potentially critical cerebrovascular lesions associated with a significant variety of unspecific symptoms ( 1 ). The dissection of an intracranial VA may remain clinically silent but more frequently manifests with posterior circulation stroke, subarachnoid hemorrhage (SAH), or, less frequently, spinal ischemia ( 2 , 3 ).…”